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General NPI Number Information
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NPI Number | 1780238741
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Entity Type | Individual
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Provider Name | CHIN CHUN PENG DDS, MSD, FACP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC STREET HEALTH AND SCIENCE CENTER D453
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City | SEATTLE
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State | WA
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Zip | 98195-0001
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Country | US
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Telephone | 206-685-6812
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Fax |
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Provider Business Mailing Address
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Address Line | 1959 NE PACIFIC STREET HEALTH SCIENCES CENTER D770C
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City | SEATTLE
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State | WA
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Zip | 98195-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DE60830423
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60830423
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License Number State | WA
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